Article
Functional Performance of Preterm Children at Age 4

https://doi.org/10.1016/j.pedn.2007.02.001Get rights and content

Functional performance, a child's ability to perform the tasks of daily living and to fulfill expected social roles, is now recommended in follow-up of preterm children. This study examined neonatal, preschool health, and motor effects on functional performance at age 4. The sample of 155 infants, classified by perinatal morbidity and birth weight, was assessed during a home visit. Neonatal illness, socioeconomic status, preschool health, and motor predictors explained 44% of the variance in functional performance. Functional performance is a useful clinical measure to understand how well preterm children perform age-expected daily activities as well as the family burden of preterm sequelae.

Section snippets

Purpose

In this study, we examine functional performance as an outcome and explore its relationships with health and motor outcomes for preschool preterm children born with varying birth weights and perinatal morbidities. We test the effect of perinatal morbidity (birth weight and neonatal illness) and preschool (age 4) health and motor development on functional performance. We hypothesize that preterm children with medical and/or neurological neonatal illness will have poorer functional performance

Literature Review

Low birth weight has adverse consequences for health and functional outcomes, and evidence shows that the percentage of children with functional limitations may be increasing (Hack et al., 2000, Vohr & Msall, 1997). Birth weight is the common predictor in preterm follow-up studies where decreasing birth weight is associated with more developmental sequelae, such that the smallest babies are likely to have later problems (Aylward, 2002a). However, not all extremely low birth weight (ELBW; <1,000

Theoretical Framework

The theoretical model for the study is derived from the bioecological model of development (Bronfenbrenner & Morris, 1998). In this model, the biopsychological organism represents the newborn infant who may have experienced prematurity and perinatal morbidity (medical illness, neurological illness, or both). The experiences of the preterm infant during the neonatal period are influenced by the processes that occur in the immediate environment called proximal processes. In turn, what happens in

Sample

The sample of 155 children, born between April 1996 and March 1999, was enrolled into one of four a priori perinatal groups according to neonatal illness and birth weight: 41 preterm infants with birth weight <1,000 g and medical illness (BPD, respiratory distress syndrome, necrotizing enterocolitis, sepsis; medical preterm group 1 [MPT1]); 39 preterm infants with birth weight ≥1,000 g and medical illness (medical preterm group 2 [MPT2]); 32 preterm infants with severe neurological illness

Results

Correlations across preschool measures of functional performance and motor scores were moderate in effect (total functional performance and motor: r = .58, p = .0001; total functional performance and visual motor integration: r = .57, p = .0001; general motor and visual motor integration: r = .55; p = .0001). Correlations of functional performance and motor scores with health status were negative, small in effect, but significant (total functional performance: r = −.21, p = .01; general motor: r

Discussion

We found moderate correlations between functional performance, health status, and motor scores. These interrelationships suggest that lower functional performance is associated with poorer motor performance and less optimal (suspect or abnormal) health status. Developmentally, a 4-year-old is expected to perform most self-care tasks with minimal assistance, such as self-toileting, dressing both upper and lower body, and hand washing. The child should also have acquired salient preschool skills

Acknowledgments

This work was supported by NIH Grant NICHD RO3 37627.

The authors wish to thank Sharon Capuano, MS, RNP, Maribeth Walesko, MS, RNP; Christina Poore, MS, RNP; Melissa MacNeill, MA; and Katheleen Hawes, MS, RN, CS, for their assistance with the home visits and data collection.

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